Aubervilliers (AFP)

"I am the Covid": since the confinement, psychiatrists from Seine-Saint-Denis see arriving at the hospital young people without history suffering from "acute delusional puffs", profiles which these caregivers "did not expect at all ".

There are those who claim "to have found the treatment for the coronavirus", those who think that "everything is their fault", those who "go into messianic delusions". And those who bluntly claim "to be the virus".

"In psychiatry, this is called a thunderbolt in a blue sky +: these are people who functioned very well and suddenly decompensate. Their relatives explain that they no longer recognize them", describes Marie-Christine Beaucousin, head of one of the 18 centers at the Ville-Evrard psychiatric hospital, which covers 80% of the Seine-Saint-Denis, department of Ile-de-France among the most affected by the epidemic.

In late March, the hospital completely reorganized to prevent the spread of the virus. The Aubervilliers center, headed by doctor Beaucousin, has become an "airlock" unit where patients are welcomed for 5 to 7 days, the time to ensure that they are not contaminated. During this period, they are in a room, with no exit rights.

For caregivers, this is a new observation post that has been created, bringing its share of "surprises".

Come to lend a hand to the teams, Antoine Zuber, psychiatrist in town in Paris, initially experienced a "very calm period". "The confinement played a containing effect. But, during this time, it heated under the casserole," he said.

"We were expecting a wave of admissions from frail patients who had discontinued treatment, and decompensations from patients who had already been followed. The surprise was to suddenly see many first episodes appear in young patients arriving in an emergency context, "said the doctor.

- Fire immolation -

To confirm these impressions, Marie-Christine Beaucousin, in office for 20 years, opened her Excel spreadsheet and compared the current data with that of a control week in March 2019.

Last year, 17% of hospitalizations concerned the first cases of psychiatric episodes, mostly men, average age 40 years. This year, 27% of those admitted to Aubervilliers had never had any problems. The average age has dropped to 34, and women are as affected as men.

Locked in their homes for several weeks due to confinement, these patients present "major anxieties which can translate, at their peak, into acute delusional flushes". "These delusional puffs can originate from depression" but also the consumption or the sudden stop of drugs, specifies Antoine Zuber.

These troubles, often megalomaniac, sometimes take the form of delusions of persecution "which translate a massive anxiety for oneself and for those around you". The caregivers therefore had to call the police for a young man who had barricaded himself in his room, convinced that there was a contract on his head.

Both psychiatrists and nurses emphasize the acute and violent nature of these crises. "In a very short time, we had an attempted self-immolation by fire, an attempted suicide by slaughtering and defenestration in front of the family entourage," recounts Xavier Faye, health executive at Ville-Evrard.

The clinical picture in psychiatry "is still very much imbued with reality", explains doctor Beaucousin, already confronted with this type of "delusional puffs" during the attacks of 2015.

In order to have a scientific analysis of this phenomenon which seems to mainly affect 18-35 year olds, the Ville-Evrard hospital has launched a "clinical containment assessment" study, led by Doctor Dominique Januel.

"An increase in acute delusional puffs is not necessarily surprising, everything is possible in psychiatry! But why in young people?" Wonders the doctor. The good news, she says, "is that it seems to be resolved fairly quickly."

In Aubervilliers, psychiatrists are already thinking of the "second wave clinic", that of deconfinement and the coming economic crisis. A concern shared by mental health professionals in all the countries affected by the pandemic, where studies show an increase in anxiety and depression.

© 2020 AFP